Background: Unexplained fatigue is frequently encountered in general practice. Because of the low prior probability of underlying somatic pathology, the positive predictive value of abnormal (blood) test results is limited in such patients. Aim: The study objectives were to investigate the relationship between established diagnoses and the occurrence of abnormal blood test results among patients with unexplained fatigue; to survey the effects of the postponement of test ordering on this relationship; and to explore consultation-related determinants of abnormal test results. Design of study: Cluster randomised trial. Setting: General practices of 91 GPs in the Netherlands. Method: GPs were randomised to immediate or postponed blood-test ordering. Patients with new unexplained fatigue were included. Limited and expanded sets of blood tests were ordered either immediately or after 4 weeks. Diagnoses during the 1 -year follow-up period were extracted from medical records. Two-by-two tables were generated. To establish independent determinants of abnormal test results, a multivariate logistic regression model was used. Results: Data of 325 patients were analysed (71% women; mean age 41 years). Eight per cent of patients had a somatic illness that was detectable by blood-test ordering. The number of false-positive test results increased in particular in the expanded test set. Patients rarely reconsulted after 4 weeks. Test postponement did not affect the distribution of patients over the two-by-two tables. No independent consultation-related determinants of abnormal test results were found. Conclusion: Results support restricting the number of tests ordered because of the increased risk of false-positive test results from expanded test sets. Although the number of reconsulting patients was small, the data do not refute the advice to postpone blood-test ordering for medical reasons in patients with unexplained fatigue in general practice.

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British Journal of General Practice
Erasmus MC: University Medical Center Rotterdam

Koch, H., van Bokhoven, M. A., ter Riet, G., van Alphen-Jager, T., van der Weijden, T., Dinant, G. J., & Bindels, P. (2009). Ordering blood tests for patients with unexplained fatigue in general practice: What does it yield? Results of the VAMPIRE trial. British Journal of General Practice, 59(561), 243–249. doi:10.3399/bjgp09X420310